Provider Demographics
NPI:1578080685
Name:CONLEY, TAYLOR BOONE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:TAYLOR
Middle Name:BOONE
Last Name:CONLEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:15 MEDICAL DR NE STE 101
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30121-8005
Mailing Address - Country:US
Mailing Address - Phone:770-386-5221
Mailing Address - Fax:770-386-1128
Practice Address - Street 1:15 MEDICAL DR NE STE 101
Practice Address - Street 2:
Practice Address - City:CARTERSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30121-8005
Practice Address - Country:US
Practice Address - Phone:770-386-5221
Practice Address - Fax:770-386-1128
Is Sole Proprietor?:No
Enumeration Date:2017-08-29
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
14133920OtherCAQH